Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients

Moreno, Gerardo; Lin, Elizabeth; Chang, Eva; Johnson, Ron L.; Berthoud, Heidi; Solomon, Cam; Morales, Leo S.

doi:10.1007/s11606-015-3500-6

Cited by 21 publications

(17 citation statements)

References 23 publications

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“…LEP patients were oversampled to attain representation by each language group, as reflected in the GHC. 6 …”

Section: Methodsmentioning

confidence: 99%

“…12–14 Prior research examined the relationship between English proficiency and use of Internet medication refill systems, and found that only 21% of LEP patients with chronic illness used the online service, compared to 53% of English proficient patients. 6 This discrepancy is not surprising, given that the majority of refill services through an online patient portal are exclusively delivered in English—but also because LEP patients are affected by many of the aforementioned sociodemographic factors that exacerbate the digital divide (lower education, lower income, foreign-born status, lower literacy levels and decreased access to technology). 6 …”

Section: Introductionmentioning

confidence: 99%

“…6 This discrepancy is not surprising, given that the majority of refill services through an online patient portal are exclusively delivered in English—but also because LEP patients are affected by many of the aforementioned sociodemographic factors that exacerbate the digital divide (lower education, lower income, foreign-born status, lower literacy levels and decreased access to technology). 6 …”

Section: Introductionmentioning

confidence: 99%

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A Digital Language Divide? The Relationship between Internet Medication Refills and Medication Adherence among Limited English Proficient (LEP) Patients

Casillas

Moreno

Grotts

et al. 2018

J. Racial and Ethnic Health Disparities

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Background: Use of an Internet portal to refill medicines positively affects medication adherence among English-speakers. No prior studies, however, have specifically examined the relationship between Internet refills and adherence among patients who are Limited English Proficient (LEP). Objectives: 1) Examine the relationship between Internet medication refill system use and medication adherence among linguistically diverse patients with chronic conditions and 2) Compare this relationship between LEP and English Proficient (EP) patients. Design, Participants, Measures: We analyzed 2013–2014 cross-sectional data from 509 surveyed adults in the Group Health Cooperative. Surveys were merged with plan enrollment, claims data, and electronic medical records. Medication adherence was calculated by the “Continuous Measure of Medication Gaps” (CMG) method. For Internet refill system use, patients were asked, “Have you used the health systems Internet site to refill any medications in the last 12 months?” LEP status was captured in the electronic medical record by a non-English primary language and a claims record of interpreter use in at least one clinical encounter between 2005–2012. We used multivariate linear regression models to examine Internet refill system use and medication adherence, and compared the association between LEP and EP patients. Results: 384 patients (75%) had a calculable CMG: 134 EP and 250 LEP in the adherence analyses. In unadjusted analyses, LEP patients had lower use of the Internet refill system (p<.001) and lower adherence versus the EP group (p<.001). In multivariate analyses, LEP status (β= −0.022, p=.047) was negatively associated with adherence, while use of the Internet refill system (β= 0.030, p=.002) was positively associated. In stratified models, use of Internet refills was positively associated with adherence, even when examining LEP (β= 0.029, p=.003) and EP patients (β= 0.027, p=.049) separately. Conclusions: These findings suggest that LEP patients may be under-utilizing a beneficial Internet tool. Should our healthcare systems fail to ensure that LEP patients have full and meaningful access to Internet patient portals, we risk worsening health care disparities.

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“…LEP patients were oversampled to attain representation by each language group, as reflected in the GHC. 6 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Digital Language Divide? The Relationship between Internet Medication Refills and Medication Adherence among Limited English Proficient (LEP) Patients

Casillas

Moreno

Grotts

et al. 2018

J. Racial and Ethnic Health Disparities

Self Cite

View full text Add to dashboard Cite

show abstract

“…And despite the political rhetoric, the U.S. continues to be a destination for persons around the world, and these immigrants often experience significant health disparities. Moreno et al 3 compared the use of remote medication refill systems among patients with limited English proficiency. They found that while health plans were increasingly relying on remote medication refills, patients whose first language is not English (e.g.…”

mentioning

confidence: 99%

International Perspectives on General Internal Medicine

Feldman

2016

J GEN INTERN MED

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“…

M oreno et al 1 examine the relationship between English proficiency and use of remote medication refill systems (that is, requesting to refill medications through automated phone or online systems rather than in person). They find that only 46 % of limited English proficient (LEP) patients with chronic illness use these services, compared to 83 % of English proficient patients.

…”

mentioning

confidence: 99%

Capsule Commentary on Moreno et al., Disparities in the Use of Internet and Telephone Medication Refills Among Linguistically Diverse Patients

Lyles

2015

J GEN INTERN MED

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M oreno et al. 1 examine the relationship between English proficiency and use of remote medication refill systems (that is, requesting to refill medications through automated phone or online systems rather than in person). They find that only 46 % of limited English proficient (LEP) patients with chronic illness use these services, compared to 83 % of English proficient patients. This discrepancy is not surprising, given that the majority of healthcare systems in the US offer these refill services only in English. The differences between English proficient and LEP patients were more pronounced for online refilling than telephone refilling, which may indicate unique barriers to online portal use among this patient subgroup. Overall, this work is consistent with growing evidence that patients with communication barriers are less likely to be able to access a variety of healthcare tools (particularly online tools) that are often designed and implemented for the mainstream patient population. 2 The study also supports the longstanding hypothesis of the Binverse care law,^3 which states that the most well resourced individuals are the first to gain from the introduction of a new technology or service. The inverse care law is most problematic in exacerbating existing health/health care disparities when the technology confers a direct health benefit. We should be concerned about this issue because there is evidence that patients who use both telephone and online refilling systems have significantly improved medication adherence (a health behavior that is clinically important, but often difficult to influence). 4,5 There is much more work to be done in this area. In particular, we need more research on why these barriers exist and how to overcome them. Technology offers a seemingly streamlined and efficient way to provide services tailored to the needs and preferences of the target group. Moreover, online patient portals are becoming a new standard for patient communication in health care; we will continue to offer more and more healthcare services through these websites to improve efficiency of care. Therefore, it is critical to focus on accessibility and usability upfront and guarantee that these services are available in languages other than English. If our bank ATMs can ask and remember our preferred language, isn't it time for our health care system to design communication technologies that do the same? This comment refers to the article available at: http://dx

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Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients

Cited by 21 publications

References 23 publications

A Digital Language Divide? The Relationship between Internet Medication Refills and Medication Adherence among Limited English Proficient (LEP) Patients

A Digital Language Divide? The Relationship between Internet Medication Refills and Medication Adherence among Limited English Proficient (LEP) Patients

International Perspectives on General Internal Medicine

Capsule Commentary on Moreno et al., Disparities in the Use of Internet and Telephone Medication Refills Among Linguistically Diverse Patients

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